Provider Demographics
NPI:1467905992
Name:LEFTWICH, WESLEY (PMHNP, FNP)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:
Last Name:LEFTWICH
Suffix:
Gender:F
Credentials:PMHNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1631 ELYSIAN FIELDS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70117-8208
Mailing Address - Country:US
Mailing Address - Phone:504-821-2601
Mailing Address - Fax:504-814-6047
Practice Address - Street 1:1631 ELYSIAN FIELDS AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70117-8208
Practice Address - Country:US
Practice Address - Phone:504-821-2601
Practice Address - Fax:504-814-6047
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN159953363LF0000X
MARN2298220363LF0000X
LAAP09915-RN159953363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2482815Medicaid